Job Description
Job Description
Company Overview
Healthcare Legal Solutions, LLC is a fast-growing healthcare collections firm that provides denial management, consulting, and corporate collections services to hospitals and health systems nationwide. Our team is collaborative, mission-driven, and focused on results. This is a great opportunity for candidates who are passionate about healthcare, legal writing, and strategy.
Position Overview
We are seeking a detail-oriented, organized, and assertive individual for our Revenue Cycle / Follow Up Specialist position. The candidate would be responsible for the basic collection of unpaid third-party claims and standard appeals, using various billing applications and third-party payer systems. A successful applicant will communicate with payers to resolve issues and facilitate prompt payment of claims. This position requires follow-up with insurance companies to progress the standard appeals process for claim denials and collect outstanding accounts for which payment has not been received. The candidate will use an understanding of claims and appeals submission requirements for payers to expedite payments and utilize a knowledge of appeals and rejections processes to resolve standard issues or escalate to a more senior staff member. This is a full-time (40 hrs / week), remote position with preference for candidates in the DC-Maryland-and Virginia area.
Specific Duties & Responsibilities
- Use HLS follow-up systems to identify unpaid claims for collection / appeal
- Use HLS follow-up systems to progress the standard appeal process for denied claims
- Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract
- Review and update patient registration information (demographic and insurance) as needed
- Resolves claim edits as needed
- Escalates any faulty accounts for correction, additional review, or delegation to more senior staff members
- Prints and mails appeals and related documents as needed
- Retrieves supporting documents (medical reports, Explanations of Benefits authorizations, etc.) as needed and submits to third-party payers
- Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility, and any other issue causing non-payment of claims
- Contacts the payers or patient as appropriate for corrective action to resolve the issue and receive payment of claims
Professional & Personal Development
Participate in on-going educational activities, meetings, and opportunitiesKeep current of industry changes by reading assigned material on work related topicsReport for in-person workdays 2-5 times per month to remain engaged in HLS office culture (preferred)Qualifications
Bachelor's Degree (BA / BS) from four-year college or university, or one to two years of related experience and / or training, or equivalent combination of education and experience.Other qualifications :BA / BS with a GPA of 3.0 or higher
Interest in healthcare and healthcare lawAbility to use various hospital, billing, and patient information computer systemsFamiliarity with compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI)Able to navigate through various computer systems and applications to find information about insurance claimsAbility to prioritize and multi-taskExcellent written and verbal communication skillsProficiency in Microsoft Office, including Word and ExcelExcellent organizational and time management skillsHigh attention to detailClear, concise, and logical writing styleContinuous performance improvement and ability to implement feedback